Designing Co-packaging for Zinc & Oral Rehydration Salts (ORS) to Influence Caregiver and Provider Behaviours for Treating Childhood Diarrhea in Guatemala

Abstract

Objectives: The Guatemalan Ministry of Public Health and Social Assistance has scaled-up co-adjunctive zinc as a national policy, yet utilization of this newly-available life-saving commodity remains a concern.  The purpose of this study was to design effective co-packaging for zinc and ORS, informed by social-marketing, to influence both caregivers' and providers' behaviours in a demonstration project at the health post level in the department of San Marcos, Guatemala.  Methods: Local concepts, perceptions and experiences relating to diarrhea and care seeking were explored in 8 focus group discussions (n=82) and 24 key informant interviews with caregivers. Prototype co-packaging and messages were developed and reviewed with 14 mothers and 10 providers in 4 municipalities to pretest the candidate materials. Results: Formative research identified two major challenges to correctly using zinc and ORS to treat childhood diarrhea: 1) the concept of adherence to zinc once symptoms disappeared; and 2) dissolving a tablet in a spoon was a new skill. A campaign of Zinc-10 was created and tested to promote the concept of 10 days of adherence to zinc; additional visual aids focussed on showing dissolving of zinc on a spoon. These candidate concepts and messages were highly accepted by caregivers and providers, yet revisions were needed for images and materials used. Conclusions: Using a social-marketing approach, packaging and promotional messages were developed that were more acceptable to caregivers and providers than the original prototypes. These materials will be tested in a randomized community trial to see the effectiveness of the co-packaging on caregiver adherence and provider behaviour.